PMS22 COST-EFFECTIVENESS ANALYSIS OF ETANERCEPT IN THE TREATMENT OF RHEUMATOID ARTHRITIS IN MEXICO

VALUE IN HEALTH 14 (2011) A1–A214

52,448) for MTX, U$ 93,992 (89,366⫺98,982) for abatacept, and $73,100 (68,539⫺ 81,877) for infliximab. The total QALYs gained(discounted) by MTX, abatacept, and infliximab during the same period were: 2.96 (2.89⫺3.03), 4.05 (3.85⫺4.30) and 3.26 (3.16⫺3.39) respectively. The Incremental Cost-Effectiveness Ratio was U$ 39,980 (36,649⫺45,011) for Abatacept compared to MTX compared to U$ 77,790 (62,369⫺98,124) per QALY gained with infliximab. CONCLUSIONS: The use of abatacept is more cost⫺effective than the use of infliximab, both compared to MTX, in patients with Rheumatoid Arthritis with IR MTX in Venezuela. PMS22 COST-EFFECTIVENESS ANALYSIS OF ETANERCEPT IN THE TREATMENT OF RHEUMATOID ARTHRITIS IN MEXICO Vargas-Valencia J1, Sotelo-Guzmán M1, Mould-Quevedo JF2, Muciño-Ortega E3, Galindo-Suarez RM3 1Econopharma Consulting S. A. de C. V., Mexico City, Mexico, 2Pfizer, New York, NY, USA, 3 Pfizer, Mexico City, Mexico

OBJECTIVES: Rheumatoid Arthrtis (RA) critically impair the quality of life of patients. Biologic treatments represent a therapeutic alternative for patients who failed disease-modifying antirheumatic drugs. However, their high cost is a challenge for clinicians and decision makers. The aim of this study was to assess the cost-effectiveness of biologic alternatives to treat RA currently available in Mexico, from an institutional perspective. METHODS: A decision-tree model was developed to simulate the clinical course of patients treated with etanercept (reference treatment), adalimumab, infliximab, tocilizumab or rituximab as first-line therapies, as well as associated costs over one-year period. Therapy continuation or treatment switch was evaluated at month 6. Effectiveness measures were: proportion of patients achieving 70% improvement in both, tender or swollen joint counts following the American College of Rheumatology (ACR70) criteria and quality adjusted life years gained (QALY=s). Costs considered included: biologics, concomitant drugs, medical follow-up and side effects management. Clinical response of alternatives was extracted from published literature, while costs were collected from Instituto Mexicano del Seguro Social (IMSS) official databases. Probabilistic sensitivity analyses were done through Monte Carlo Simulation second-order approach. RESULTS: The effectiveness of therapies resulted in [ACR70, QALY=s]: etanercept [31.3%, 0.79]; adalimumab [18.1%, 0.77]; infliximab [12.8%, 0.73]; tocilizumab [21.1%, 0.77] and rituximab [11.9%, 0.75]. Expected mean costs per patient were: US$12,914.36 [95%CI US$12,901.58-US$12,927.08]; US$15,715.06 [95%CI US$15,699.73-US$15,730.39]; US$14,479.96 [95%CI 14,465.77-US$14,494.16]; US$44,455.03 [95%CI US$44,411.53US$44,498.53] and US$17,267.61 [95%CI US$17,250-US$17,284.53], respectively. Etanercept is both, the less costly and the most effective alternative: US$31,504.80 less than tocilizumab (the most costly alternative) and 19.3% more patients meet the ACR70 criteria regarding rituximab (the less effective alternative). Acceptability curves showed that etanercept regardless willingness to pay would be the most cost-effective biologic. CONCLUSIONS: Due to their lower costs and favorable effectiveness profile, etanercept is dominant over other biologic treatments in the management of RA at IMSS. PMS23 COST-EFFECTIVENESS ANALYSIS OF ANALGESIC THERAPY FOR POSTOPERATIVE PAIN AFTER TOTAL HIP ARTHROPLASTY IN MEXICO Contreras I1, Mould-Quevedo JF2, Goycochea-Robles MV1, Torres-Gonzalez R1, Garduño-Espinosa J3 1Instituto Mexicano del Seguro Social, México City, Mexico, 2Pfizer, New York, NY, USA, 3 Hospital Infantil de Mexico Federico Gómez, México City, Mexico

OBJECTIVES: Inappropriate analgesia in postoperative pain (POP) raises hospitalization costs and increases the burden of several surgeries with a meaningful impact over patient’s quality of life. The objective of this study was to develop an economic analysis to evaluate parecoxib, ketorolac and morphine in the treatment of POP in patients who underwent total hip arthroplasty from an institutional perspective. METHODS: A cost-effectiveness analysis was developed using a Bayesian decision-tree model, to simulate costs and effectiveness outcomes over the postoperative hospitalization period (15 days). Comparators were multimodal analgesics: morphine (52 mg/day) plus parecoxib (40 mg/day); morphine (52 mg/ day) plus ketorolac (90 mg/day) and morphine (57 mg/day) alone. Effectiveness measures were: percentage of treatment response without adverse events (AE) meeting the highest score of the patient’s global evaluation survey (excellent). Effectiveness data and transition probabilities were collected from international published literature. Resource use and cost data was gathered from hospital records of patients undergoing total hip arthroplasty at the Social Security Mexican Institute (IMSS) (n⫽89). The model was calibrated according to international pharmacoeconomics guidelines. One-way and probabilistic sensitivity analyses were performed with Monte Carlo Simulation second-order approach. RESULTS: Patients who received parecoxib exhibited 41% of treatment response, followed by morphine (26%) and ketorolac (24%). Estimated costs per patient were lower with parecoxib (US$ 5,439.30) followed by ketorolac (US$5,538.91) and morphine (US$5,553.71). No statistical differences were found among the costs of analgesic therapies (p⬎0.05). Parecoxib showed a weak dominance against its competitors. Acceptability curves showed parecoxib as the most cost-effective therapy with 95% when willingness to pay is US$6,500. CONCLUSIONS: Results show that at the IMSS, parecoxib is a cost-effective treatment that significantly reduces POP in patients who underwent total hip arthropasty. This information could be useful for developing markets healthcare institutions in order to establish efficient analgesics improving current health outcomes.

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PMS24 THE COST EFFECTIVENESS OF STRONTIUM RANELATE VERSUS RISEDRONATE, RALOXIFENE, IBANDRONATE, ALENDRONATE AND CALCITONIN IN THE TREATMENT OF POSTMENOPAUSAL OSTEOPOROTIC WOMEN IN TURKEY Malhan S1, Cetin A2, Gur A3, Kavuncu V4, Tan M5 1 Baskent University, Ankara, Turkey, 2Hacettepe University, Ankara, Turkey, 3Gaziantep University, Gaziantep, Turkey, 4Kocatepe University, Afyon, Turkey, 5Servier Ilac ve Arastirma A.S., Istanbul, Turkey

OBJECTIVES: The goal of this study was to estimate the cost-effectiveness of strontium ranelate in the treatment of postmenopausal osteoporotic women in Turkey. METHODS: A validated Markov microsimulation model with a Turkish payer’s perspective estimated the cost per quality-adjusted life-year (QALY) of strontium ranelate treatment compared with risedronate, raloxifene, ibandronate, alendronate and calcitonin. Markov Model was used and applied in the Treeage Pro software over a cohort of 1000 patients in the pharmacoeconomical analysis. As for the sensitivity analysis, the Monte Carlo Simulation was used, applying a simulation of 10.000. Data on the effect of both treatments on fracture risk were taken from the literature. The cost of the treatments were calculated based on Turkish reimbursement systems, the indirect and intangible costs were omitted. The direct disease costs include the amount spent for the costs associated with the outpatient, inpatient, medical supplies, all the laboratory or imaging tests and the interventions performed. The costs of the side effects were added to all the drug costs. The official product summaries were used for detecting the side effects of the products. RESULTS: Strontium Ranelate provides the highest gain of quality life years and is the superlative therapeutical choice with respect to QALY. According to it’s cost and effectiveness value, strontium ranelate was dominant (i.e. more effective and less costly) versus ibandronate and calcitonine for postmenopausal osteoporotic women. The cost per QALY gained by strontium ranelate compared to ibandronate was € 5582 and calcitonine was € 3943. Compared to alendronate, risedronate and raloxifene, strontium ranelate was cost effective (i.e. more costly but more effective). CONCLUSIONS: The results of this study suggest that strontium ranelate is a cost-effective strategy, in a Turkish setting, for the treatment of postmenopausal osteoporotic women. PMS25 COST-EFFECTIVENESS OF ABATACEPT OR INFLIXIMAB IN RHEUMATOID ARTHRITIS IN COLOMBIA Alfonso-Cristancho R1, Aiello EC2, Roa CN3 1 University of Washington, Seattle, WA, USA, 2Bristol-Myers Squibb, Buenos Aires, Argentina, 3 Bristol-Myers Squibb, Bogota, Colombia

OBJECTIVES: Determine the cost⫺effectiveness of abatacept or infliximab in patients with rheumatoid arthritis (RA) with inadequate response to methotrexate (IR⫺MTX) in Colombia. METHODS: Dynamic simulation techniques from a previously validated model and clinical data from published literature were used for the analysis. The functional disability was assessed using the Health Assessment Questionnaire (HAQ). A HAQ score was randomly assigned pre⫺treatment based on the prevalence of the disease and the demographic characteristics for Colombia, then projected over time using the efficacy results from published trials. Direct medical costs were calculated from private and public hospitals,and the information system of the Ministry of Social Protection (SISMED) and validated with local experts (Exchange rate: $1,920 Colombian peso⫽1 US Dollar). A 10⫺year time horizon and the payer’s perspective were assumed. Costs and health outcomes were discounted at 3% annually. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the results of the model. RESULTS: In a hypothetical cohort of 1,000 patients with RA ⫺ IR MTX, the costs of treatmentfor the first year for MTX were U$794 dollars, compared to U$16,659 for abatacept and U$17,531 for infliximab, assuming dosages for average patients below 60 kg. Additional analysis with patients over 60 kg were included in the sensitivity analysis. After 10 years of follow⫺up the discounted total direct medical costs per patient were U$55,998 (54,354⫺57,776) for MTX, U$99,888 (94,694⫺104,437) for abatacept, and $79,174 (75,795⫺83,899)for infliximab. The total number of QALYs gained (discounted) by MTX, abatacept, and infliximab were: 2.88 (2.79⫺2.95), 3.94 (3.79⫺4.09) and 3.17 (3.09⫺3.27) respectively. The calculated ICERs for abatacept and infliximab compared to MTX were U$ 37,513 (35,221⫺39,909) and U$75,873 (62,825⫺103,132) per QALY gained, respectively. CONCLUSIONS: In patients with RA ⫺ IR MTX in Colombia, the use of abatacept is more cost-effective than the use of infliximab, both compared to MTX. PMS26 COST-EFFECTIVENESS MODELING IN OSTEOPOROSIS: A SYSTEMATIC LITERATURE REVIEW AND OVERVIEW Smolen HJ, Myers JA, Smolen LJ Medical Decision Modeling Inc., Indianapolis, IN, USA

OBJECTIVES: To conduct a structured review of the recent osteoporosis cost-effectiveness modeling literature and provide an overview of their methodologies and approaches. METHODS: A detailed systematic review was performed of the following literature databases: MEDLINE, MEDLINE In-Process, EMBASE, Cochrane, HEED, NHSEED, EconLit, and googlescholar. Using pre-selected inclusion/exclusion criteria relevant studies published since January 2005 were identified. Relevant information from each identified study was extracted according to a predefined grid and essential features of each osteoporosis cost-effectiveness model were recorded. RESULTS: Forty-eight relevant and recently published osteoporosis cost-effectiveness models were identified. Model structures were cohort Markov (56%) and individualized microsimulations (44%). Most models (35) used a lifetime timeframe (i.e., death or ⱖ age 100). The primary interventions investigated were bisphosphonates (79%), raloxefine (15%), and hormone replacement therapy (10%). In 98% of